For the second year in a row, the Centers for Medicare and Medicaid Services has reported a reduction in improper Medicare claims payments as a result of increased oversight.
The level of improper Medicare claims payments dropped from 5.2 percent of all claims in 2005 to 4.4 percent in 2006, representing a total savings of $1.3 billion.
Outgoing CMS Administrator Mark McClellan, MD, noted that increased efforts are paying off. “Because we are able to measure the accuracy of payments more closely now, we are able to target our efforts more effectively with Medicare contractors and providers,” he said.
However, Kip Piper, president of Health Results Group, said the industry should be cautious about using the metric of recovery-after-the-fact as the only metric of success. “It is only one in a series of metrics to judge CMS’s performance,” he said.
CMS uses two analytic tools that compile national and state-specific information, which then is used to determine where potential hospital payment errors occur, a CMS spokesperson said.
The First-look Analysis Tool for Hospital Outlier Monitoring, or FATHOM, produces state-specific hospital reports on areas of potential payment errors. CMS recently produced state-specific analyses to refine state-level interventions.
Improper payment information helps CMS identify the root cause of claim errors and enables CMS to adjust strategies and improve compliance in payment, documentation and provider billing practices.